Some patients in South Carolina are forced to choose between affording health care or putting food on the table.
Many patients, especially those living with rare, complex or chronic diseases, rely on third-party financial assistance to pay for medications to maintain their health and manage their symptoms. However, health insurers in South Carolina block this financial assistance from counting towards a patient’s deductible or out-of-pocket costs. As a result, patients are unaware that their deductibles have not been met and may not be able to afford their care. It is up to South Carolina lawmakers to protect patients and ensure that South Carolinians have access to the medicines they need.
Many patients rely on copay assistance programs in the form of coupon cards to afford high-cost medications to manage their health. These discount programs help patients afford their care and provide a critical lifeline for people with rare, chronic and complex diseases, many of whom do not have access to generic alternatives to treat their conditions. More than 99% of copay assistance programmes are used for conditions that have no generic equivalent.
However, some insurance companies in South Carolina are increasing their use of “copay accumulator programs”, which allow companies to refuse to apply the value of payments made through copay assistance programs to a patient’s annual deductible. Insurance companies use the copay assistance funds until the voucher card has met the full contracted maximum deductible, and then reset the patient’s deductible back to zero. Unaware of the reset, patients may show up at a pharmacy counter and be confronted with their full deductible, which they must pay before they can access their medication.
Co-payments increase the cost of healthcare and allow health insurers to improve their bottom line at the expense of patients. Copay assistance can be provided by drug manufacturers, charities, churches or other third parties and is vital for many patients. For many families in our country with high-cost medications, financial assistance is the only way to afford the out-of-pocket costs needed to stay healthy. Yet four out of five marketplace insurance plans in South Carolina have copay accumulator policies.
Studies show that more than two out of three Americans stop taking prescription drugs when their out-of-pocket costs reach $250. When a patient’s share of prescription costs becomes too high, it increases the likelihood of skipping or abandoning treatment, leading to even higher medical costs down the road through increased emergency room visits or long-term health problems.
Today, patients with blood disorders ranging from haemophilia to sickle cell disease can live normal and successful lives as long as they have access to their medications. As deductibles and out-of-pocket costs continue to rise, South Carolina families should not be penalized for using copay assistance programs to help them afford the treatments they need.
Fortunately, South Carolina lawmakers in Columbia are considering H3618, which would prohibit the use of copay accumulator programs and allow patients to count the use of copay assistance programs towards their out-of-pocket costs.
Additionally, at the federal level, Congress is considering similar legislation that would protect millions of Americans living with chronic conditions through the bipartisan HELP Copays Act H.R. 830, introduced by Rep. Buddy Carter and Rep. Nanette Barragán. This legislation would prohibit policies that allow pharmacy benefit managers to siphon off copay assistance funds from patients, providing much-needed relief. The HELP Copays Act has the potential to make a difference nationally, but our state lawmakers should join the 20 states, including Georgia, North Carolina, Virginia, Tennessee and Texas, that have already passed similar legislation to count any copay assistance toward a patient’s deductible or out-of-pocket costs and protect patients from these predatory tactics.
Insurance companies in South Carolina should not be allowed to block copay assistance from counting towards a patient’s deductible, especially for those living with chronic conditions. H3618 and the HELP Copays Act are critical to helping individuals access essential and life-saving medical care for those we serve at the Bleeding Disorder Association of South Carolina, the L.D. Barksdale Sickle Cell Anemia Foundation, and the many others living with chronic and rare diseases in South Carolina.
We urge South Carolina legislators to pass H3618 and support the HELP Copays Act to ensure that all copayments made towards a patient’s deductible or out-of-pocket costs are accepted. It is time to make all copays count in the Palmetto State.
Sue Martin is the executive director of the Bleeding Disorders Association of South Carolina, which serves all 46 counties in South Carolina. She is the mother of a child with haemophilia.
Rhonda Young is the executive director of the Louvenia D. Barksdale Sickle Cell Anemia Foundation, which serves 15 counties in Upstate South Carolina.
